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The cold truth

A lingering cough or cold can be extremely irritating, but many of us are asking our GPs for antibiotics too soon, rather than waiting for the virus to run its course. Lisa Salmon visits the doc to find out more.

By Lisa Salmon

Coughs and colds are as common as Christmas trees at this time of year. But, while most people know exactly when they'll be taking the tree down, few appear to be aware of how long their cold should last.

Research by the Men's Health Forum indicates that, within four to seven days of having cold-like symptoms, both men and women tend to give up self-treatment and seek advice from a doctor.

This means many of us will be asking for antibiotics that we really don't need, rather than persevering with over-the-counter remedies, or waiting a little longer for the virus to run its course.

"The symptoms of common winter illnesses such as coughs, colds and sore throats can often last longer than people expect, but antibiotics aren't the right treatment for these conditions," says Sheila Kelly, chief executive of the over-the-counter medicines trade association PAGB (Proprietary Association of Great Britain).

Dr Maureen Baker, health protection spokesperson for the Royal College of GPs, agrees. "When it's a purely viral illness like most colds, flu, the winter vomiting bug and chicken pox, antibiotics will have no effect whatsoever," she says.

Of course, sometimes what starts as a cold can develop into something more serious - particularly for those who are already vulnerable, such as babies, the elderly, or people whose immune systems may be weaker due to other ongoing health conditions or treatments they're on.

And it is possible for a bacterial illness to develop on top of a virus - for example, somebody with flu may develop bacterial pneumonia - but this is rare.

"That's not the common course of the illness," stresses Baker. "The vast majority of people with a viral illness will have no bacterial complications."

Generally speaking, many of us underestimate how long the symptoms of common minor winter ailments can last.

According to the National Institute for Health and Clinical Excellence (NICE), it's not unusual for a cough to last three weeks, sinusitis can last two and a half, and a cold can linger for up to a week and a half.

Baker advises people check out the information on the NHS Choices website (www.nhs.uk) if they are unsure. "People should use their common sense - if symptoms are significantly worse than normal, or there are other symptoms that are worrying you, or you start to feel really ill, get more information or seek help," she adds.

People can make more use of their local pharmacists, too, who can offer advice on suitable over-the-counter treatments, especially if people are taking painkillers, such as paracetamol and ibuprofen, at the same time. Many non-prescription cold and flu remedies contain paracetamol too, which is why reading the labels is so crucial, to avoid potentially serious overdosing.

Leyla Hannbeck, head of pharmacy at the National Pharmacy Association, says: "Some people research their symptoms on the internet and believe whatever they read and start self-treating, which isn't the best way of doing things."

She points out that most pharmacies have a consultation room, or people can just pop in for a quick informal chat.

"It's not just about the condition, it's about other medications the person might be on," she explains. "Not all painkillers go together, and not all cough syrups go with particular medications, so it's important to have a discussion about it."

Here's an outline of what you should expect from winter ailments.

Colds

Typical symptoms include a blocked or runny nose, sneezing, irritated throat, cough, headache and general feeling of being run-down. Colds usually last four or five days but, like most viruses, occasionally they'll linger for a week or two. When the viral infection has settled, symptoms such as a cough or feeling congested may last for several weeks.

"In general, there's no need to consult a doctor unless people think they're becoming worse rather than better or develop new or worrying symptoms, like coughing up blood," says Baker.

Sore throat

The vast majority (more than 90%) of sore throats (pharyngitis or tonsillitis) are caused by viral infections and don't respond to antibiotics or other medication, says Baker, who advises that patients should rest, drink plenty of fluids and try throat sweets or hot drinks with honey and lemon.

Occasionally people have more severe symptoms, such as a very high fever, severe pain or difficulty swallowing - in which case a visit to the doctor is advisable. "It's perfectly reasonable for anyone with severe symptoms, or patients at greater risk such as the immunosuppressed, to seek medical advice," says Baker.

Flu

Many people mistake a bad cold for flu. However, as well as cold symptoms, flu typically also entails a sudden fever/high temperature, loss of appetite, sometimes nausea, general weakness and aches. People with flu may feel extremely unwell and unable to get out of bed.

So far this winter there haven't been a significant amount of flu cases - Baker says only Norovirus (winter vomiting sickness) cases have shown a slight rise above the seasonal norm.

Most people who have flu will begin to feel better after a few days, but some will react very badly to the virus.

"I don't class flu as a minor illness, even though most people will be fine," Baker stresses. "There's always a danger with flu that there isn't with a cold. If after two or three days people are starting to get worse rather than better, that's when it would be reasonable to get checked by a doctor. What we worry about is bacterial or viral pneumonia."

Cough

The majority of coughs, though they can sound awful and are extremely annoying to have, are not serious. However, a cough can persist for as long as three weeks - because although the infection may have gone, there could still be inflammation, or airways may have become irritated.

Coughs can sometimes be a sign of something more serious going on though - especially if accompanied by other worrying signs like blood and a tight chest. And coughs that get worse, rather than better, should be checked out by a GP too.

When to see a doctor

Though most of us can safely wait out or self-treat coughs and colds, Dr Baker says medical advice should be sought if:

:: A young baby is unwell and has a fever.

:: People have serious underlying conditions, or are more prone to getting a bacterial infection because of a weakened immune system, possibly because they're taking steroids or having cancer treatment.

:: Someone becomes very ill, with symptoms including very high fever, breathing difficulties and inability to take fluids, even if their illness originally started with mild symptoms.